CARING (CAncer Risk and INsulin analoGues): The Association of Diabetes Mellitus and Cancer Risk with Focus on Possible Determinants - A Systematic Review and a Meta-Analysis

Starup-Linde, Jakob; Karlstad, Øystein; Eriksen, Stine Aistrup; Vestergaard, Peter; Bronsveld, Heleen K; Vries, Frank de; Andersen, Morten; Auvinen, Anssi; Haukka, Jari; Hjellvik, Vidar; Bazelier, Marloes T; Boer, Anthonius de; Furu, Kari; Bruin, Marie L De

doi:10.2174/15748863113086660071

Cited by 59 publications

(51 citation statements)

References 215 publications

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“…We further excluded narrative reviews and meta-analyses that had only one study, did not report the necessary study-specific data including the relative risk (RR) and 95% confidence intervals (CI) or the number of endometrial cancer cases and controls or total population. 14,[54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71] Where two or more meta-analyses examined the exact same association, we chose the largest meta-analysis to avoid duplicate assessment of the same primary studies; the concordance between included and duplicate meta-analyses was explored in a sensitivity analysis (Supporting Information).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Risk factors for endometrial cancer: An umbrella review of the literature

Raglan

Kalliala

Markozannes

et al. 2019

Intl Journal of Cancer

358

289

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Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over‐ or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta‐analyses of observational studies evaluating the association between non‐genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random‐effects summary estimate, largest study included, number of cases, between‐study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta‐analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta‐analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist‐to‐hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m2 1.49; CI 1.39–1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13–1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60–0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.

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Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Risk factors for endometrial cancer: An umbrella review of the literature

Raglan

Kalliala

Markozannes

et al. 2019

Intl Journal of Cancer

358

289

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“…the insulin-like growth receptor pathway [5,19]. Women with diabetes have a 15–20% increased risk of breast cancer compared to women without diabetes [6–9], but no impact of insulin analogue treatment has been shown [5]. Breast cancer in women with diabetes is often diagnosed at an advanced stage compared to women without diabetes [13,14,20–22].…”

Section: Introductionmentioning

confidence: 99%

Diabetes and Breast Cancer Subtypes

et al. 2017

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BackgroundWomen with diabetes have a worse survival after breast cancer diagnosis compared to women without diabetes. This may be due to a different etiological profile, leading to the development of more aggressive breast cancer subtypes. Our aim was to investigate whether insulin and non-insulin treated women with diabetes develop specific clinicopathological breast cancer subtypes compared to women without diabetes.Methods and FindingsThis cross-sectional study included randomly selected patients with invasive breast cancer diagnosed in 2000–2010. Stratified by age at breast cancer diagnosis (≤50 and >50 years), women with diabetes were 2:1 frequency-matched on year of birth and age at breast cancer diagnosis (both in 10-year categories) to women without diabetes, to select ~300 patients with tumor tissue available. Tumor MicroArrays were stained by immunohistochemistry for estrogen and progesterone receptor (ER, PR), HER2, Ki67, CK5/6, CK14, and p63. A pathologist scored all stains and revised morphology and grade. Associations between diabetes/insulin treatment and clinicopathological subtypes were analyzed using multivariable logistic regression. Morphology and grade were not significantly different between women with diabetes (n = 211) and women without diabetes (n = 101), irrespective of menopausal status. Premenopausal women with diabetes tended to have more often PR-negative (OR = 2.44(95%CI:1.07–5.55)), HER2-negative (OR = 2.84(95%CI:1.11–7.22)), and basal-like (OR = 3.14(95%CI:1.03–9.60) tumors than the women without diabetes, with non-significantly increased frequencies of ER-negative (OR = 2.48(95%CI:0.95–6.45)) and triple negative (OR = 2.60(95%CI:0.88–7.67) tumors. After adjustment for age and BMI, the associations remained similar in size but less significant. We observed no evidence for associations of clinicopathological subtypes with diabetes in postmenopausal women, or with insulin treatment in general.ConclusionsWe found no compelling evidence that women with diabetes, treated with or without insulin, develop different breast cancer subtypes than women without diabetes. However, premenopausal women with diabetes tended to develop breast tumors that do not express hormonal receptors, which are typically associated with poor prognosis.

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“…It is also possible that immune competency is significantly different between clinical populations. For example, diabetics with decreased immune competence have a significantly increased incidence of cancer (Starup-Linde et al 2013).…”

Section: Recent Ata Guidelines (2009) To Assess the Risk Of Dtc Recurmentioning

confidence: 99%

Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

Blumhardt¹,

Wolin²,

Phillips³

et al. 2014

Endocrine-Related Cancer

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Differentiated thyroid cancer (DTC) is the most common endocrine malignancy and the fifth most common cancer in women. DTC therapy requires a multimodal approach, including surgery, which is beyond the scope of this paper. However, for over 50 years, the postoperative management of the DTC post-thyroidectomy patient has included radioactive iodine (RAI) ablation and/or therapy. Before 2000, a typical RAI post-operative dose recommendation was 100 mCi for remnant ablation, 150 mCi for locoregional nodal disease, and 175-200 mCi for distant metastases. Recent recommendations have been made to decrease the dose in order to limit the perceived adverse effects of RAI including salivary gland dysfunction and inducing secondary primary malignancies. A significant controversy has thus arisen regarding the use of RAI, particularly in the management of the low-risk DTC patient. This debate includes the definition of the low-risk patient, RAI dose selection, and whether or not RAI is needed in all patients. To allow the reader to form an opinion regarding post-operative RAI therapy in DTC, a literature review of the risks and benefits is presented.

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CARING (CAncer Risk and INsulin analoGues): The Association of Diabetes Mellitus and Cancer Risk with Focus on Possible Determinants - A Systematic Review and a Meta-Analysis

Cited by 59 publications

References 215 publications

Risk factors for endometrial cancer: An umbrella review of the literature

Risk factors for endometrial cancer: An umbrella review of the literature

Diabetes and Breast Cancer Subtypes

Current controversies in the initial post-surgical radioactive iodine therapy for thyroid cancer: a narrative review

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